health service delivery in nigeria managing the organizational environments

Journal of Biology, Agriculture and Healthcare

ISSN 2224-3208 (Paper) ISSN 2225

Vol.3, No.4, 2013

Health Service Delivery

Department of Political Science

Abstract

The issue of poor performance by the public sector in Nigeria has been a topical one. While the prin

growing function of Governments in the developing countries like Nigeria is to ensure an equitable distribution of

public goods and services to its citizens, service delivery in the country has not only been below public expectations,

it has also not been integrated into the public sector operations, processes, procedures, workings and management. In

the public health sector, the situation is worrisome because of the nexus between health statuses, human and

institutional capacity as well as nation

of environmental stakeholders in quality service delivery derived its data from in

secondary sources. The study recommended, among others, the exigency

orientation in the public health sector, proactive and pragmatic management of health institutions and organizations

as well as their interface with key environmental stake holders (players) and concerns and a synergis

systemic practice.

Keywords: health, service delivery, organizational environment and performance.

1. Introduction

Service, that has become the focus of increasing managerial attention and represents a major portion of the

economies of the world’s developed countries is at the heart of organizational performance, whether in the public or

private realm. The centrality of service in public and private sector organizations and institutions is inextricably

linked to the functionality, operationality, growth and development of societies because such organizations and

institutions exist in, operate and are shaped by their environments. Service delivery therefore requires management

of the en v has sundry stakeholders including external customers

internal customers that are critical to external customers satisfaction and loyalty, suppliers creditors, regulators and

the like This view-point is hinged on the understanding that the above environment

players with a valuable role in the service delivery process

In the public sector, despite the expectations of the public and the strategic role of the sector its poor performance has

been a topical one (Ejumudo 2010). A

attack for lack of performance In fact while public sector organizations and institutions are the shopping floor for

government business, Nigerians have regrettably been short

Notably, governmental organizations have over the years been showcases for the combined evils of inefficiency

ineffectiveness lawlessness and corruption and, as a consequence, impediments to effective implemen

government policies. It is therefore not surprising that in 1984 the African Association for Public Administration and

Management organized a round table conference in Nairobi where the public service crisis was discussed (AAPAM

1984) and in December 2003 a team of experts was commissioned to re the state of service delivery in Nigeria

including the examination of the institutional environment for service delivery the reflection on people’s views and

experiences and the determination of a road map

suggest that services in Nigeria are not serving the people they are inaccessible poor in quality and indifferent to

customers’ needs As a result public confidence is poor, inequality leve

confusing and wasteful No wonder the United States Ambassador to Nigeria, Terence McCulley, identified

non-performing public health system as one of the reasons why Nigeria is underdeveloped (Vanguard 2011)

Since the primary purpose of Government is to improve the quality of life of its citizens the need for a far reaching

transformation of the Nigerian public sector through action based service delivery programmes that will serve as a

step in the process of actualizing a people

a reality. To this end, public institutions that have a social obligation to render services to the people have to brace up


3208 (Paper) ISSN 2225-093X (Online)

35

Health Service Delivery in Nigeria: Managing The Organizational

Environments

Kelly Bryan Ovie Ejumudo, Ph.D

Department of Political Science, Delta State University, Abraka, Nigeria

The issue of poor performance by the public sector in Nigeria has been a topical one. While the prin



not been integrated into the public sector operations, processes, procedures, workings and management. In


institutional capacity as well as national development. This study which examines the critical role of the management

of environmental stakeholders in quality service delivery derived its data from in-depth analysis of valuable

secondary sources. The study recommended, among others, the exigency of a service culture and development


as well as their interface with key environmental stake holders (players) and concerns and a synergis

health, service delivery, organizational environment and performance.


he world’s developed countries is at the heart of organizational performance, whether in the public or


onality, growth and development of societies because such organizations and


of the en v has sundry stakeholders including external customers that expect real value for their money employees or


point is hinged on the understanding that the above environmental stakeholders are critical active

players with a valuable role in the service delivery process


been a topical one (Ejumudo 2010). Although public sector performance was taken for granted they are today under


government business, Nigerians have regrettably been short-changed by the quality of public service delivery


ineffectiveness lawlessness and corruption and, as a consequence, impediments to effective implemen



mber 2003 a team of experts was commissioned to re the state of service delivery in Nigeria


experiences and the determination of a road map for effective service delivery programmes The committee s findings


customers’ needs As a result public confidence is poor, inequality level is high and institutional arrangements are


performing public health system as one of the reasons why Nigeria is underdeveloped (Vanguard 2011)

e the primary purpose of Government is to improve the quality of life of its citizens the need for a far reaching


alizing a people-oriented government that is not disconnected from the people has become


www.iiste.org

Organizational

Delta State University, Abraka, Nigeria

The issue of poor performance by the public sector in Nigeria has been a topical one. While the principal and



not been integrated into the public sector operations, processes, procedures, workings and management. In


al development. This study which examines the critical role of the management

depth analysis of valuable

of a service culture and development


as well as their interface with key environmental stake holders (players) and concerns and a synergistic mentality and


he world’s developed countries is at the heart of organizational performance, whether in the public or


onality, growth and development of societies because such organizations and


that expect real value for their money employees or


al stakeholders are critical active


lthough public sector performance was taken for granted they are today under


nged by the quality of public service delivery


ineffectiveness lawlessness and corruption and, as a consequence, impediments to effective implementation of



mber 2003 a team of experts was commissioned to re the state of service delivery in Nigeria


for effective service delivery programmes The committee s findings


l is high and institutional arrangements are


performing public health system as one of the reasons why Nigeria is underdeveloped (Vanguard 2011)

e the primary purpose of Government is to improve the quality of life of its citizens the need for a far reaching


oriented government that is not disconnected from the people has become




Vol.3, No.4, 2013

to meet and exceed their legitimate expecta

paid lip service to its development, management and service delivery capacity, efficiency and effectiveness. Such lip

service has the concomitant effect of neglecting the management co

development plans and programmes. This study therefore examines the critical role of managing the environmental

stakeholders in the health sector for quality service delivery in Nigeria and recommends an attitude and

change and collaboration with the key environmental players where service delivery is esteemed as the culture, going

concern and logic behind public health sector existence.

2. Methodology

This study adopted a qualitative case study method. This

aspects viz: investigation of a contemporary phenomenon within its real life context, the existence of boundaries

between the phenomenon and the real life context and the use of multiple sources of

study method also lends itself to exploratory, descriptive and explanatory methods. Yin emphasized that exploratory

research attempts to find out about a situation, while the descriptive and explanatory research types respec

to know “what happened” and how and “why it happened.” This study which examined electoral fraud and the

legitimacy crisis in Nigeria however attempted a description and an explanation of electoral fraud and the

implication for the legitimacy crisis of governments and governance in Nigeria through in

secondary sources of data.

3. Service: A Conceptual Clarification

The word service was derived from the Latin word “servus” which means slave (Ericson 2009). Services

been associated with menial work performed by low or unskilled workers. Technological advances in manufacturing

during the Industrial Revolution of the 19th century decreased the labor required to produce goods and at the same

time improved the standard of living (Campbell

available to provide them increased. But it has been only with the past 50 years or so that there has been significant

growth in services in industrialized

current economic period is often referred to as the information or service economy, which is considered the successor

to the manufacturing or industrial economy that succeeded th

middle of the 19th century.

Services, until recently, were not considered to add value to an economy (Ejumudo 2009). As a result, measures of

service activities were not even included in the calculation of t

services were usually lumped into a miscellaneous or tertiary category behind agriculture, mining and manufacturing,

particularly in the Third World or undeveloped countries. Today, services constitute

the more highly developed countries, and economic data are now available on many of the major service sectors

within these economies, a possible explanation for the search by many customers for something more than just good

service. Technology is also transforming the way services are delivered and will continue to do so for the foreseeable

future. In the past, service managers typically faced a trade

example, if customers wanted low cost, then it was provided with slower service or less personalized service.

While these trade-offs still exist, technology is allowing managers to move to a superior performance or trade

curve, thereby creating or adding value for the c

services. Value can take the form of more personalized services as when you check into hotels like Grand hotel in

Asaba, Wellington hotel at Effurun and Sheraton in Abuja and the staff kno

you certain preferences. The key for the service organization in creating or adding value for the customer is to

provide additional benefits. And to sustainably gain and enjoy the cutting

industry, organizational players have to go beyond customer satisfaction extra mile efforts so as to produce customer

loyalty that sectoral or market leaders necessarily seek.

4. Health Services: A Conceptual Explanation

Health services include all services dealing with the diagnosis and treatment of disease or the promotion,

maintenance and restoration of health (Cayer 2005; Oyibo 2010). They include personal and non

services. A way to look at services is to divide them into t

some degree of overlap: service industries, ancillary and support services and services in the manufacturing industry.



36

to meet and exceed their legitimate expectations. In the health sub-sector, successive governments in Nigeria have


service has the concomitant effect of neglecting the management component in the implementation of health


stakeholders in the health sector for quality service delivery in Nigeria and recommends an attitude and


concern and logic behind public health sector existence.

This study adopted a qualitative case study method. This research method, according to Robert Yin (2003), has three


between the phenomenon and the real life context and the use of multiple sources of evidence. The qualitative case


research attempts to find out about a situation, while the descriptive and explanatory research types respec



y crisis of governments and governance in Nigeria through in

Service: A Conceptual Clarification

The word service was derived from the Latin word “servus” which means slave (Ericson 2009). Services



standard of living (Campbell et al. 2009). As a result, both the demand for services and the labour


growth in services in industrialized countries, catalyzed in large part by advances in information technology. The


to the manufacturing or industrial economy that succeeded the agrarian economy that was dominant through the


service activities were not even included in the calculation of the gross national product (GNP) of a country. Instead,


particularly in the Third World or undeveloped countries. Today, services constitute a major portion of economies in




future. In the past, service managers typically faced a trade-off in terms of what to provide to their customers. For

ers wanted low cost, then it was provided with slower service or less personalized service.

offs still exist, technology is allowing managers to move to a superior performance or trade

curve, thereby creating or adding value for the customer in the form of faster, lower cost, and/or more personalized


Asaba, Wellington hotel at Effurun and Sheraton in Abuja and the staff knows you have stayed there before and give


provide additional benefits. And to sustainably gain and enjoy the cutting-edge advantage in any servi


loyalty that sectoral or market leaders necessarily seek.

Health Services: A Conceptual Explanation

de all services dealing with the diagnosis and treatment of disease or the promotion,

maintenance and restoration of health (Cayer 2005; Oyibo 2010). They include personal and non

services. A way to look at services is to divide them into the following three broad sectors, recognizing that there


www.iiste.org

sector, successive governments in Nigeria have


mponent in the implementation of health


stakeholders in the health sector for quality service delivery in Nigeria and recommends an attitude and climate


research method, according to Robert Yin (2003), has three


evidence. The qualitative case


research attempts to find out about a situation, while the descriptive and explanatory research types respectively seek



y crisis of governments and governance in Nigeria through in-depth analysis of valuable

The word service was derived from the Latin word “servus” which means slave (Ericson 2009). Services have often



2009). As a result, both the demand for services and the labour


countries, catalyzed in large part by advances in information technology. The


e agrarian economy that was dominant through the


he gross national product (GNP) of a country. Instead,


a major portion of economies in




off in terms of what to provide to their customers. For

ers wanted low cost, then it was provided with slower service or less personalized service.

offs still exist, technology is allowing managers to move to a superior performance or trade-off

ustomer in the form of faster, lower cost, and/or more personalized


ws you have stayed there before and give


edge advantage in any service sector or


de all services dealing with the diagnosis and treatment of disease or the promotion,

maintenance and restoration of health (Cayer 2005; Oyibo 2010). They include personal and non-personal health

he following three broad sectors, recognizing that there




Vol.3, No.4, 2013

More specifically, the service sectors include health care, hospitality, financi

services and transportation. Health services are the most visible functions of any health system, both to users and the

general public. Service provision refers to the way inputs such as money, human resource, equ

combined to allow the delivery of health interventions. Improving access, coverage and quality of services therefore

depends on the availability of these key resources; on the ways services are organized and managed and on the

incentives influencing providers and users. In the healthcare business, effective management is needed to ensure that

quality services are provided to those in need.

Effective health service delivery in any country is concerned with bringing about an acceptable le

programmes that will assist the country to provide health care to populations having insufficient or no access to

health services. It should therefore develop guidelines for National Health Service systems, expressed in terms of

their component parts that can he adapted and developed according to national needs. There should be a strong

national will to undertake effective intensive action and the country should structure its health services by effective

operation in the shortest possible ti

management methods capable of implementing the decisions taken. Besides, it should adapt and put into use health

technology methods, techniques, equipment, etc that are accepta

And finally it should encourage participation, involvement arid coordination in the planning, implementation,

monitoring and evaluation of the services by local population and national and sometimes intern

can further the achievement of National Health Service goals. In sum, health services that consist of a network of

institutions run by the government as part of a country’s health administrative system and provide certain

indispensable medical care and preventive services should be both accessible and acceptable to the entire population,

suited to its needs and the socio-economic conditions of the country.

5. Health Sector Organizations and their Environments

Organizations including those in the health sector exist and operate in environments which imply that they have to

manage the interface between them and the sundry stakeholders in the relevant environments. The environment,

whether public, private or voluntary, connotes personalit

are relatively enduring over time, typifying an organization and distinguishing it from other organizations (Knowles

1982; Forehand and Gilmer 1962; Hefiriegel and Slocum 1974). Such a set of ch

environment, ecology or climate and it has the tendency or potency of influencing the attitude of its members

including individuals, organizations and societies (Pritchard and Karasick 1993; Taguirui 1998). Environment or

climate which is a commonly experienced but an abstract phenomenon, and often referred to by many expressions

such as atmosphere milieu and culture is a relatively enduring quality of the internal environment that is felt by its

members.

Environment that influence organizational behaviour and can be described in terms of the values of organizations,

societies and the like (Taguirui 1998) can also be viewed as a global expression of what an organization or a society

is (Schneider and Snyder 1995) Environmen

organization society or any social system relate or interface with its environment (Webb 2000) consists of multiple or

diverse dimensions (Campbell et al.

while others are indifferent, cold, hostile and competitive (Aldag and Brief 2004) The supportive and warm climate

is the type that encourages and protects the individual s sense of personal worth and importance

unsupportive and cold type is the defensive and manipulative one.

In every organization or society certain factors or elements exert profound influence on the existing environment or

climate that is created or constructed whether by design or acci

instance, identified five factors that influence climatic creation or construction viz context structure, process system

values and norms Climate whether supportive or hostile is critical and can be chan

(Gordon and Goldberg 1977; McClelland and Bumham 1976).

Environment can be internal or external and this leads to the problem of delineating or defining the boundary

between the organization and its external environment or b

organization s environment Some people consider patients in the hospital and students in the university to be part of

the internal environment Others see these groups as customers or consumers of the servi

respective organizations and place them in the external environment Most people agree, however that those

individuals employed and financially remunerated for their work are part of the internal environment of



37

More specifically, the service sectors include health care, hospitality, financial services, professional services, retail


general public. Service provision refers to the way inputs such as money, human resource, equ



es influencing providers and users. In the healthcare business, effective management is needed to ensure that

quality services are provided to those in need.

Effective health service delivery in any country is concerned with bringing about an acceptable le



nent parts that can he adapted and developed according to national needs. There should be a strong


operation in the shortest possible time. It should also employ effective resources allocation, systems analysis, and


technology methods, techniques, equipment, etc that are acceptable to the users and those for whom they are used.


monitoring and evaluation of the services by local population and national and sometimes intern



e medical care and preventive services should be both accessible and acceptable to the entire population,

economic conditions of the country.

Health Sector Organizations and their Environments

hose in the health sector exist and operate in environments which imply that they have to


whether public, private or voluntary, connotes personality (Aldag and Brief 2004). It is a set of characteristics that


1982; Forehand and Gilmer 1962; Hefiriegel and Slocum 1974). Such a set of characteristics create a distinctive





influence organizational behaviour and can be described in terms of the values of organizations,


is (Schneider and Snyder 1995) Environment or climate which can equally be conceptualized as the study of how an


et al. 2009) Some environments or climates are considerable warm and supportive


is the type that encourages and protects the individual s sense of personal worth and importance

unsupportive and cold type is the defensive and manipulative one.


climate that is created or constructed whether by design or accidental (Rao et al. 1997) James and Jones (1974), for


values and norms Climate whether supportive or hostile is critical and can be changed, recreated or reconstructed

(Gordon and Goldberg 1977; McClelland and Bumham 1976).


between the organization and its external environment or between the internal and external components of the


the internal environment Others see these groups as customers or consumers of the servi



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al services, professional services, retail


general public. Service provision refers to the way inputs such as money, human resource, equipment and drugs are



es influencing providers and users. In the healthcare business, effective management is needed to ensure that

Effective health service delivery in any country is concerned with bringing about an acceptable level of coherent



nent parts that can he adapted and developed according to national needs. There should be a strong


me. It should also employ effective resources allocation, systems analysis, and


ble to the users and those for whom they are used.


monitoring and evaluation of the services by local population and national and sometimes international agencies that



e medical care and preventive services should be both accessible and acceptable to the entire population,

hose in the health sector exist and operate in environments which imply that they have to


y (Aldag and Brief 2004). It is a set of characteristics that


aracteristics create a distinctive





influence organizational behaviour and can be described in terms of the values of organizations,


t or climate which can equally be conceptualized as the study of how an


imates are considerable warm and supportive


is the type that encourages and protects the individual s sense of personal worth and importance while an


1997) James and Jones (1974), for


ged, recreated or reconstructed


etween the internal and external components of the


the internal environment Others see these groups as customers or consumers of the services offered by the two





Vol.3, No.4, 2013

organizations All the same while it is reasonable to include within the organizations’ environment all those who

influence decision making in the organization, it is instructive to note that patients and students only enjoy access to

the relevant organizations environments becau

Essentially organizations largely depend on their internal and external environments for survival Inputs come from

the external environment into the organization Levine and White (1991) referred to the

in the external environment as domain and arguably these relevant others must be recognized and considered in the

managerial decision-making process. Dill (1998) and Pickle and Abrahamson, (2009) clarified the concept of

relevant others when they classified the various stakeholders as follows:

5.1 Customers

All the players or stakeholders in an organization are essential to its functionality, operationality and survival;

however, the customers are the most important group bec

production of economic goods and services for the satisfaction of wants and needs. The customer receives these

goods and services and, in addition, they provide the money for management to satisfy other pa

Without the customer, management would be unable to satisfy any group. The customer needs an acceptable quality

of goods and services at an acceptable price. Some customers want higher quality goods and services, but expect to

pay a higher price for them. What is acceptable quality and price also change constantly. Since the economic system

uses competition as motivating device, the satisfaction of customers is a relative and ever

organization must therefore attempt to equal or exceed the efforts of its competitors to satisfy customers. In their

attempts to compete, organizations continually change their offerings of goods and services. What satisfies the

customer today may not necessarily satisfy him the next da

constantly in terms of quality and price. Customers are thus critical to organizational performance, functionality and

renewal.

5.2 Employees

Health institutions or organizations need employees to produ

on the organization for monetary rewards, security and good working conditions as well as many other economic,

psychological, and social satisfactions. Development of large organizations after the Indust

allowed absentee owners to bring pressure on management to increase the satisfaction of the owner group at the

expense of the employee group. Some of them made use of this power. One employee was of little importance when

he was only one out of hundreds or even thousands. Employees did try to combine their efforts and engage in

collective bargaining. However, most had little success because management used various methods to avoid

collective bargaining, such as firing employees who

were also members of a free and democratic society. Extensive labor legislation was the result of these managers

being unwilling to satisfy the employee group. Today, employees are not to be seen a

and fired. They are, in fact, the most critical and valuable resource, because all the other resources including financial

investments are dormant except they are activated by the human element. Here, health personnel are e

organize and direct the other resources for result

the inevitability of employees recognizing and accepting their status and utilitarian value as internal customers whose

inputs are critical to each other’s output.

5.3 Suppliers

Suppliers are those organizations that provide raw materials, equipment, tools, and any other economic goods or

services that the dependent organization uses in the production of economic goods and ser

their own individual wants and needs that management must satisfy. The purchasing health organizations like the

university teaching or specialist hospitals are also customers to the suppliers. Just as the supplier cannot exist wi

the buying organization, the suppliers are critical to the service delivery in the health sector because they provide the

necessary physical and material resources including equipment. The satisfaction of suppliers is therefore of

paramount importance to the health institutions and organizations, especially as the world is in a competitive

environment.

5.4 Creditors

Creditors are vital parties-at-interest in the public health sector because when administrators need funds to assemble

the factors of production, they must often turn to creditors. As with other parties

particular wants and needs. They demand security of their funds and a payment of interest that is equal to the security

of their funds. Management of the he



38

ame while it is reasonable to include within the organizations’ environment all those who


the relevant organizations environments because of the nature of the services they seek or require


the external environment into the organization Levine and White (1991) referred to the collectivity of relevant others


making process. Dill (1998) and Pickle and Abrahamson, (2009) clarified the concept of

evant others when they classified the various stakeholders as follows:


however, the customers are the most important group because the organization’s over


goods and services and, in addition, they provide the money for management to satisfy other pa



higher price for them. What is acceptable quality and price also change constantly. Since the economic system

uses competition as motivating device, the satisfaction of customers is a relative and ever

empt to equal or exceed the efforts of its competitors to satisfy customers. In their


customer today may not necessarily satisfy him the next day and consequently the demands of the customer change


Health institutions or organizations need employees to produce economic goods and services. The employees depend


psychological, and social satisfactions. Development of large organizations after the Indust



ly one out of hundreds or even thousands. Employees did try to combine their efforts and engage in


collective bargaining, such as firing employees who talked about or tried to form unions. These same employees


being unwilling to satisfy the employee group. Today, employees are not to be seen as mere variable cost to be hired


investments are dormant except they are activated by the human element. Here, health personnel are e

organize and direct the other resources for result-oriented service delivery in public health institutions. This explains


uts are critical to each other’s output.


services that the dependent organization uses in the production of economic goods and ser


university teaching or specialist hospitals are also customers to the suppliers. Just as the supplier cannot exist wi



e to the health institutions and organizations, especially as the world is in a competitive

interest in the public health sector because when administrators need funds to assemble

duction, they must often turn to creditors. As with other parties-at interest, creditors have their


of their funds. Management of the health institutions and organizations must satisfy the wants and needs of creditors

www.iiste.org

ame while it is reasonable to include within the organizations’ environment all those who


se of the nature of the services they seek or require


collectivity of relevant others


making process. Dill (1998) and Pickle and Abrahamson, (2009) clarified the concept of


ause the organization’s over-riding purpose is the


goods and services and, in addition, they provide the money for management to satisfy other parties or stakeholders.



higher price for them. What is acceptable quality and price also change constantly. Since the economic system

uses competition as motivating device, the satisfaction of customers is a relative and ever- changing concept. The

empt to equal or exceed the efforts of its competitors to satisfy customers. In their


y and consequently the demands of the customer change


ce economic goods and services. The employees depend


psychological, and social satisfactions. Development of large organizations after the Industrial Revolution actually



ly one out of hundreds or even thousands. Employees did try to combine their efforts and engage in


talked about or tried to form unions. These same employees


s mere variable cost to be hired


investments are dormant except they are activated by the human element. Here, health personnel are expected to

oriented service delivery in public health institutions. This explains



services that the dependent organization uses in the production of economic goods and services. Suppliers also have


university teaching or specialist hospitals are also customers to the suppliers. Just as the supplier cannot exist without



e to the health institutions and organizations, especially as the world is in a competitive

interest in the public health sector because when administrators need funds to assemble

at interest, creditors have their


alth institutions and organizations must satisfy the wants and needs of creditors



Vol.3, No.4, 2013

if they expect to obtain more funds in the future. In other words, if management does not repay monies borrowed,

plus the specified interest rates, it will have a hard time b

on management to force satisfaction of their wants and heeds. Creditors thus play a facilitating and complementary

role to public health institutions and organizations, especially when government’s

delayed due to bureaucratic red-tapism.

5.5 Government and Owners

Local, state, and federal governments are a necessary parties

provide the social structure needed for the prod

roadways, flood control, police and fire protection, legal systems, national defense, and many other services that are

essential to the operation of any health institution and organization. In retu

support and finance these governments in their operations. Consequently, governments have their own peculiar wants

and needs. In order for governments to continue effective operations, organizations must provide appro

support for the basic concepts of the existing government. Financial support of these governments is a different

matter, for governments have immediate and powerful weapons with which they are able to force management to

satisfy this need. Since governments at all levels are critical .to the operationality and functionality of public health

institutions and organizations, the management of such institutions must take the government into consideration in

their day- to-day operations and activities. A

factors of production; the latter are essential to customer satisfaction and loyalty. In the public health sector,

government as the owner has a critical role to play in service deliver

funds which are investments without which desirable returns in the form of efficient and effective service delivery

cannot be a reality. It is therefore incumbent on public sector health institutions to man

investors.

5.6 Communities

For the most part, the communities have wants and needs are they expect the management of health institutions and

organizations to be an integral part of the society or environment and to improve and en

community. Management must, for instance, help the communities in their efforts to enhance the environment for

public good. Health institutions and organizations can also develop more intensive training programs to train the

people who have been unable to obtain jobs because of lack of skills. Of course, some of the motivation for

management’s contribution to these areas has been because of governmental action. In addition, management must

support many of the local community’s organiza

indefinite in its actions if its wants and needs are not satisfied. The philosophy and culture of corporate social

responsibility has however become an issue that public health instituti

the private sector have to adequately address as part of compensation to their operating environment and contribution

to the development of society

5.7 Competitors

Of all the parties-at interest, competitor

satisfaction in respect of their needs and wants In a system that relies on competition as a major motivating force the

only form of satisfaction that management owes its competito

few weapons at their command with which to force management to satisfy their wants and needs. However,

competitors, like customers and employees, are also citizens in a free, democratic society and have

powers It should also be noted that the satisfaction of competitors has a degree of relationship with satisfaction of

customers, for only through competition does management obtain maximum satisfaction of the customer group In

fact, competition is the motivating force that produces maximum satisfaction of human wants and needs Therefore, if

management is not fair and equitable in its practices toward competitors, then customers cannot obtain maximum

satisfaction,

6. A Critical Assessment of Public Health Service Delivery in Nigeria

The public sector as the sector of the economy established and operated by the government and its agencies is

distinguishable from the private sector and organized on behalf of the citizenry The public sector is in

state that deals with the delivery of goods and services by and for the government whether at the national, regional

state or the local level and its activities include delivering social services and security, administering urban planning

and organizing national defenses. In so far as organizations exist as part of government machinery for implementing



39


plus the specified interest rates, it will have a hard time borrowing. Consequently, creditors exert a strong influence


role to public health institutions and organizations, especially when government’s funds are inadequate or are

tapism.

Local, state, and federal governments are a necessary parties-at-interest in any organization. These governments

provide the social structure needed for the production of economic goods and services. Governments provide


essential to the operation of any health institution and organization. In return for these services, management must


and needs. In order for governments to continue effective operations, organizations must provide appro



vernments at all levels are critical .to the operationality and functionality of public health


day operations and activities. Again, since organizations use governments/owners funds to purchase the


government as the owner has a critical role to play in service delivery primarily due to the fact that they provide the


cannot be a reality. It is therefore incumbent on public sector health institutions to manage the owners who are the


organizations to be an integral part of the society or environment and to improve and en



o have been unable to obtain jobs because of lack of skills. Of course, some of the motivation for


support many of the local community’s organizations drives and initiatives. The community is traditionally slow and


responsibility has however become an issue that public health institutions and organizations, like their counterparts in


at interest, competitors are probably of least importance to management and thus require the least


only form of satisfaction that management owes its competitors is fair and honest practices Competitors have very


competitors, like customers and employees, are also citizens in a free, democratic society and have



on is the motivating force that produces maximum satisfaction of human wants and needs Therefore, if


ublic Health Service Delivery in Nigeria


distinguishable from the private sector and organized on behalf of the citizenry The public sector is in




www.iiste.org


orrowing. Consequently, creditors exert a strong influence


funds are inadequate or are

interest in any organization. These governments

uction of economic goods and services. Governments provide


rn for these services, management must


and needs. In order for governments to continue effective operations, organizations must provide approval and



vernments at all levels are critical .to the operationality and functionality of public health


gain, since organizations use governments/owners funds to purchase the


y primarily due to the fact that they provide the


age the owners who are the


organizations to be an integral part of the society or environment and to improve and enhance life within the



o have been unable to obtain jobs because of lack of skills. Of course, some of the motivation for


tions drives and initiatives. The community is traditionally slow and


ons and organizations, like their counterparts in


s are probably of least importance to management and thus require the least


rs is fair and honest practices Competitors have very


competitors, like customers and employees, are also citizens in a free, democratic society and have equal voting



on is the motivating force that produces maximum satisfaction of human wants and needs Therefore, if



distinguishable from the private sector and organized on behalf of the citizenry The public sector is in fact part of the






Vol.3, No.4, 2013

policy decisions and delivering services that are of value to citizens the critical issue is whether there is adequate

capacity for the expected quality of service delivery on a sustainable basis.

As far as the public health sector is concerned the primary responsibility of the organizations or institutions is to

deliver services that the private sector may not deliver at all or to deliver ser

market price of the product Fundamentally the ability of a government to legitimately tax and govern people is

premised on its capacity to deliver a range of services required by its population which no other player wil

(Olowu 2005). In other words governments owe their existence and their legitimacy to the fact that there are services

in which the possibility of market failure is great. Services include those that can be financed by user charges

referred to as utilities and those that can only be financed by taxes referred to as services. Although interest has

shifted to the partnering and complementary possible roles of the private sector, voluntary organizations, and

communities in improving the delivery of pu

institutional failures and poor services. Essentially, advances in technology have increased the possibility of greater

involvement of several institutional actors in the provision

involvement in governmental decision making has compelled governments to seek to enhance the quality of

government services at a time when the available resources for delivering such services have suffered d

With the poor quality of governance in Nigeria, the delivery of services in the public health sector has notably

continually been constrained. Arguably, some incremental efforts have been made in terms of policy formulation and

programme execution; such efforts have not significantly translated into concrete improvement and enhancement of

public service delivery in the health sector. Two plausible explanations for the poor performance are the decline in

governance and near absence of quality culture

governments that they do not need to dominate the provision of services. They only need, as a matter of exigency, to

provide the enabling environment and play their own roles in an increasingly c

consequence, the current focus on governance as the totality of institutional structures within a political community

as distinct from government that is the state’s instrument for formulating and implementing public pol

helped to strengthen the case for institutional capacity and diversity for the efficient and effective delivery of public

services in the developing world like Nigeria. The contention of the United Nations Development Programme

(UNDP) that sustainable development can be attained only when the tripod of public, private and voluntary sector

institutions are recognized, accepted and utilized as legitimate actors in the governance arena depicts the utilitarian

value of collaboration, synergy and inter

The levels of health care in Nigeria are: tertiary level which is the domain of the Federal Government, secondary or

intermediate care level that is under the control of the state governments and the primary health care

lowest governmental level of health care under the jurisdiction of the local governments. The tertiary level that the

responsibility rests with the Federal Ministry of Health headed by the Minister of Health is the highest level of health

care and it provides mutually supportive referral system to the secondary care level. It provides specialist and

rehabilitative, while the secondary level provides mutually supportive referral system to the primary health care level

that provides at least the essential elements of primary health care that are delivered at the first point of contact

between individuals and the health care system. Health service delivery structures are also largely tiered, and federal

and state parastatal and agencies have been c

different levels. The management of facility based service delivery is tangled in this structure.

The general understanding is that while policy development remains the responsibility of the Fed

those health issues that have national impact and cross border implications, State Governments may choose to

respond to these national directions in the context of local priorities they have established. They also develop their

own policy documents to which state budgets then respond. Responsibility for service delivery is also shared. Again,

the general understanding is that the Federal Government is responsible for tertiary care and training of selected

health professionals, state governments for secondary care and supervisory oversight of local government health

units who are, in turn, responsible for the provision of primary care service delivery activities and its integration

community-based outreach and support activities. The tiere

years, been plagued by sundry factors including poor funding and management, disconnect between health policy

initiatives, reforms and programmes of different regimes and weak institutional and huma

The Health and Development Dialogue (HDD) of 2005 had described the Nigerian Health Care Delivery System as

blind, lacking the vision of its goals and strategies; ailing and deaf to respond to the cries of the sick and the dying,

impotent, seemingly incapable of doing things its neighbouring states have mastered. The WHO (2006) summary



40


cted quality of service delivery on a sustainable basis.


deliver services that the private sector may not deliver at all or to deliver services to those who cannot afford the


premised on its capacity to deliver a range of services required by its population which no other player wil



utilities and those that can only be financed by taxes referred to as services. Although interest has


communities in improving the delivery of public services, the public sector is under severe attack for weak capacity,


involvement of several institutional actors in the provision of health services, the need for greater citizen


government services at a time when the available resources for delivering such services have suffered d



such efforts have not significantly translated into concrete improvement and enhancement of


governance and near absence of quality culture. There is therefore a growing recognition and acceptance by


provide the enabling environment and play their own roles in an increasingly complex governance environment. As a


as distinct from government that is the state’s instrument for formulating and implementing public pol



nable development can be attained only when the tripod of public, private and voluntary sector


value of collaboration, synergy and interdependence in today’s service world.


intermediate care level that is under the control of the state governments and the primary health care



and it provides mutually supportive referral system to the secondary care level. It provides specialist and


essential elements of primary health care that are delivered at the first point of contact


and state parastatal and agencies have been created to implement programmes and manage services across the


The general understanding is that while policy development remains the responsibility of the Fed



cy documents to which state budgets then respond. Responsibility for service delivery is also shared. Again,


rnments for secondary care and supervisory oversight of local government health


based outreach and support activities. The tiered health service delivery system in Nigeria has, over the


initiatives, reforms and programmes of different regimes and weak institutional and human capacity building.



ent, seemingly incapable of doing things its neighbouring states have mastered. The WHO (2006) summary

www.iiste.org



vices to those who cannot afford the


premised on its capacity to deliver a range of services required by its population which no other player will provide



utilities and those that can only be financed by taxes referred to as services. Although interest has


blic services, the public sector is under severe attack for weak capacity,


of health services, the need for greater citizen


government services at a time when the available resources for delivering such services have suffered decline.



such efforts have not significantly translated into concrete improvement and enhancement of


. There is therefore a growing recognition and acceptance by


omplex governance environment. As a


as distinct from government that is the state’s instrument for formulating and implementing public policies has



nable development can be attained only when the tripod of public, private and voluntary sector



intermediate care level that is under the control of the state governments and the primary health care that is the



and it provides mutually supportive referral system to the secondary care level. It provides specialist and


essential elements of primary health care that are delivered at the first point of contact


reated to implement programmes and manage services across the


The general understanding is that while policy development remains the responsibility of the Federal Government for



cy documents to which state budgets then respond. Responsibility for service delivery is also shared. Again,


rnments for secondary care and supervisory oversight of local government health


d health service delivery system in Nigeria has, over the


n capacity building.



ent, seemingly incapable of doing things its neighbouring states have mastered. The WHO (2006) summary



Vol.3, No.4, 2013

index of the performance of health systems ranking of its 191 member states also placed Nigeria in the 87 position,

just ahead of Sierra Leone, Myanmar,

war torn countries. The health sector performance in Nigeria had been largely unacceptable as Odumosu et al. (2009)

rightly articulated. The health service delivery palaver in Nig

Ministry of Health with the support of the National Council on Health (NCH) decided to undertake a Health Sector

Reform (HSR) to improve the performance of the health service system for better health status

areas of concern as identified by the above ministry included defining the stewardship roles of the three tiers of

government, strengthening the national service delivery system and its management, reducing the disease burden due

to priority health problems, ensuring the availability of adequate health services, improving access to quality health

services, enhancing customers awareness and community involvement in health and promoting effective partnership

and co-ordination.

Beyond the national concern about the urgent need to respond to the health sector crisis with the focus on improving

the stewardship role of government at all its operational levels, fragmentation continues to weaken referral capacity,

promote duplication of service delivery and health promotion actions and limit the relevance of systematic analysis

of needs. Vertically managed priority control programmes also take pride of the day, exacerbating systems challenges

and inefficiencies in the management of resources f

cause of failure remains the yawning gap between plans and achievements, inadequate funding, poor management of

available health resources, disconnect between health policy initiatives, refor

regimes, near absence of evaluation culture, relative neglect of preventive health service, increasing cost and poor

access, inequity and pro-rich mentality and approach to health service issues and weak institutional and hum

capacity building. At the heart of the above problems and constraints is the poor realization of the value of and the

actual management of the demands of the key environmental stakeholders and concerns of the health sector in

Nigeria. The utilitarian value of the management of the environmental demands is arguably critical to delivery of

quality and result- oriented services in Nigeria’s health Sector.

7. Managing the Health Sector Environment for Effective and Result

Culture and Development Orientation in Nigeria

Although good health is critical to human welfare and socio

been facing daunting challenges. Considerable awareness and recognition of the challeng

sector reforms in Nigeria. The adoption of the Millennium Development Goals (MDG5) policy paper and the

Nigerian Economic Empowerment and Development Strategy (NEEDS) initiative were also stimulants to the

reforms. With the reforms, there has been a groundswell of activities supposedly aimed at tackling the problems

underlying the health sector over the decades In pursuance of the reform agenda the Federal Ministry of Health

convened a meeting of stakeholders to examine the public pri

by which the abundant health care resources in the private sector could be harnessed for the benefit of the population

(FMOH 2005) The Federal Ministry of Health has also made some efforts to maintain an

performance.

In the face of the relatively well articulated health policies and implemented programmes and activities, the health of

the Nigerian people is still being threatened and impaired by a largely poor and inefficient he

delivery system (Aregbeyen 2004) Although it has been argued that despite the tight financial constraints in most

developing countries significant improvements in health are still possible if the health authorities in these countries

would consider effecting major restructuring of their health sectors for the purpose of enhancing efficiency, equity

and effectiveness (World Bank 2004) the central issue is the poor realization of the benefits and value of the interface

between the environmental stakeholders and concerns as well as the failure to effectively manage same for quality

and result-oriented service delivery. After all, the key indicator of efficient and effective health care service delivery

is the provision of health care at minima

explains why the first and primary step in the actualization of an enhanced pro

delivery in Nigeria, is the recognition, acceptance, utilization an

relationship between the different yet critical environmental concerns in the health sector.

This above environmental management will have an in built and in

development orientation. In this direction, the exigency of a proactive and pragmatic management of the sundry

stakeholders viz customers employees, suppliers creditors government/owners communities and competitors cannot

be over-emphasized This management requires ana



41


just ahead of Sierra Leone, Myanmar, Central African Republic and the Democratic Republic of Congo, post conflict


rightly articulated. The health service delivery palaver in Nigeria reached a frightening level that the Federal


Reform (HSR) to improve the performance of the health service system for better health status



priority health problems, ensuring the availability of adequate health services, improving access to quality health


he national concern about the urgent need to respond to the health sector crisis with the focus on improving


ce delivery and health promotion actions and limit the relevance of systematic analysis


and inefficiencies in the management of resources for health care service delivery in Nigeria. The most significant


available health resources, disconnect between health policy initiatives, reforms and programmes of different


rich mentality and approach to health service issues and weak institutional and hum



lue of the management of the environmental demands is arguably critical to delivery of

oriented services in Nigeria’s health Sector.

Managing the Health Sector Environment for Effective and Result- Oriented Service Delivery through S

Culture and Development Orientation in Nigeria

Although good health is critical to human welfare and socio-economic development, the health sector in Nigeria has

been facing daunting challenges. Considerable awareness and recognition of the challeng



there has been a groundswell of activities supposedly aimed at tackling the problems


convened a meeting of stakeholders to examine the public private partnership (PPP) option and the ways and means


(FMOH 2005) The Federal Ministry of Health has also made some efforts to maintain an


the Nigerian people is still being threatened and impaired by a largely poor and inefficient he



d consider effecting major restructuring of their health sectors for the purpose of enhancing efficiency, equity


tal stakeholders and concerns as well as the failure to effectively manage same for quality

oriented service delivery. After all, the key indicator of efficient and effective health care service delivery

is the provision of health care at minimal cost for public good, which is for maximal benefit and impact. This

explains why the first and primary step in the actualization of an enhanced pro-active and quality health care service

delivery in Nigeria, is the recognition, acceptance, utilization and management of the interdependence and inter

relationship between the different yet critical environmental concerns in the health sector.

This above environmental management will have an in built and in-grained full-blown service culture and

rientation. In this direction, the exigency of a proactive and pragmatic management of the sundry


emphasized This management requires analyzing, understanding and recognizing customers’ needs and

www.iiste.org


Central African Republic and the Democratic Republic of Congo, post conflict


eria reached a frightening level that the Federal


Reform (HSR) to improve the performance of the health service system for better health status of the population. The



priority health problems, ensuring the availability of adequate health services, improving access to quality health


he national concern about the urgent need to respond to the health sector crisis with the focus on improving


ce delivery and health promotion actions and limit the relevance of systematic analysis


or health care service delivery in Nigeria. The most significant


ms and programmes of different


rich mentality and approach to health service issues and weak institutional and human



lue of the management of the environmental demands is arguably critical to delivery of

Oriented Service Delivery through Service

economic development, the health sector in Nigeria has

been facing daunting challenges. Considerable awareness and recognition of the challenges prompted the health



there has been a groundswell of activities supposedly aimed at tackling the problems


vate partnership (PPP) option and the ways and means


(FMOH 2005) The Federal Ministry of Health has also made some efforts to maintain and improve the health sector


the Nigerian people is still being threatened and impaired by a largely poor and inefficient health care service



d consider effecting major restructuring of their health sectors for the purpose of enhancing efficiency, equity


tal stakeholders and concerns as well as the failure to effectively manage same for quality

oriented service delivery. After all, the key indicator of efficient and effective health care service delivery

l cost for public good, which is for maximal benefit and impact. This

active and quality health care service

d management of the interdependence and inter

blown service culture and

rientation. In this direction, the exigency of a proactive and pragmatic management of the sundry


lyzing, understanding and recognizing customers’ needs and



Vol.3, No.4, 2013

expectations in public health service delivery principally because they (customers) are the focus and beneficiaries of

any services requested and offered It therefore follows that the service cultu

service seekers as the king and the reason for the existence of public health service institutions (providers). In this

light, public sector health service providers will strive to meet the expectations of customers (

through quality and result oriented services Quality services here will include adequate resource allocation and

deployment that will culminate in creating the right and clement environment with the appropriate infrastructure,

facilities, equipment and drugs The above environment is inevitable considering the fact that several studies

(Erinosho 2008; Adetuberu 2004) have documented the limited capacity (due to poor infrastructural base and

management of health care and inadequate hea

of Nigerians.

In as much as managing the customer side of public health sector service delivery in Nigeria is necessary, it is not

sufficient. This assertion implies that the employees

organizations, they are also critical to meeting the expectations of health service seekers (external customers) and

possibly exceed same by going extra mile. Health sector personnel should

and exposure so that they can be properly skilled, knowledgeable and fit to apply them for enhanced service delivery

in the public health sector, especially as institutional capacity is largely a product of the qu

which is at the heart of the wealth of nations (Ejumudo 2010). The valuable nature of the human side of public health

sector organizations is evident in the fact that all other resources have to efficiently and effectively deploy

utilized by the human resource for quality service delivery. This key human asset is critically desirable because lack

of competent and skilled manpower is to a large extent known and accepted to have contributed to the relative non

performing status of public health sector institutions (Aregbeyen 2004). After all, human resources development and

personnel management are central to the achievement of effective reforms, improved quality of health services,

enhanced health status and customer satisfac

knowledgeable and having the right capacity and attitudinal disposition is therefore desirable and expedient for

efficient and effective service delivery in the Nigerian public health sector.

Another critical variable in the management of environmental stakeholders and concerns is finance that is the

life-wire in any health service delivery. Central to the finance element or aspect are suppliers, creditors and

governments or owners. And since quali

processes and services with quality people having the requisite skills, knowledge and ability to work to peak

performance in order to meet the needs and expectations of custom

organizations and institutions should, as a matter of exigency, manage its interface with the governments/owners,

creditors and suppliers. Again, since quality service delivery means quality equipment, drugs and f

institutions are expected to leverage on constant and appropriate supplies from organizations with quality products

that will be financed by the various levels of government supported and enhanced by sundry creditors (financial

institutions) that provide for the financial short

deficit groups by the latter. Given the age

sector by successive Nigerian governments (Unicef 2007), the need for enhanced financial sectoral allocation and

efficient utilization of same for the provision of health services cannot be over

availability of health facilities and quality services are la

finance.

Generally, the flow of government funding to the health care system in Nigeria has been disappointingly low. For

instance, the average annual federal government expenditure on health bet

government allocation to the federal ministry of health are indicated in table 1 and 2 below:



42


any services requested and offered It therefore follows that the service culture that it demands will see the health


light, public sector health service providers will strive to meet the expectations of customers (



ities, equipment and drugs The above environment is inevitable considering the fact that several studies


management of health care and inadequate health manpower) of health institutions to cater for the health care needs


sufficient. This assertion implies that the employees are not only internal customers in public health institutions and


possibly exceed same by going extra mile. Health sector personnel should therefore have the right quality training


in the public health sector, especially as institutional capacity is largely a product of the qu


sector organizations is evident in the fact that all other resources have to efficiently and effectively deploy


of competent and skilled manpower is to a large extent known and accepted to have contributed to the relative non

us of public health sector institutions (Aregbeyen 2004). After all, human resources development and


enhanced health status and customer satisfaction. A well managed mix of human resource that is skilled,


efficient and effective service delivery in the Nigerian public health sector.

her critical variable in the management of environmental stakeholders and concerns is finance that is the

wire in any health service delivery. Central to the finance element or aspect are suppliers, creditors and

governments or owners. And since quality and result-oriented orientation and practice implies achieving quality in all


performance in order to meet the needs and expectations of customers or health care seekers, health service


creditors and suppliers. Again, since quality service delivery means quality equipment, drugs and f



ns) that provide for the financial short-fall of the former through the intermediation between surplus and

deficit groups by the latter. Given the age-long weak financial support for and poor investment in the public health

vernments (Unicef 2007), the need for enhanced financial sectoral allocation and

efficient utilization of same for the provision of health services cannot be over-emphasized. After all, adequate

availability of health facilities and quality services are largely determined by substantial provision and utilization of


instance, the average annual federal government expenditure on health between 2001 and 2004 and the federal


www.iiste.org


re that it demands will see the health


light, public sector health service providers will strive to meet the expectations of customers (health service seekers)



ities, equipment and drugs The above environment is inevitable considering the fact that several studies


lth manpower) of health institutions to cater for the health care needs


are not only internal customers in public health institutions and


therefore have the right quality training


in the public health sector, especially as institutional capacity is largely a product of the quality of the human element


sector organizations is evident in the fact that all other resources have to efficiently and effectively deployed and


of competent and skilled manpower is to a large extent known and accepted to have contributed to the relative non-

us of public health sector institutions (Aregbeyen 2004). After all, human resources development and


tion. A well managed mix of human resource that is skilled,


her critical variable in the management of environmental stakeholders and concerns is finance that is the

wire in any health service delivery. Central to the finance element or aspect are suppliers, creditors and

oriented orientation and practice implies achieving quality in all


ers or health care seekers, health service


creditors and suppliers. Again, since quality service delivery means quality equipment, drugs and facilities, health



fall of the former through the intermediation between surplus and

long weak financial support for and poor investment in the public health

vernments (Unicef 2007), the need for enhanced financial sectoral allocation and

emphasized. After all, adequate

rgely determined by substantial provision and utilization of


ween 2001 and 2004 and the federal




Vol.3, No.4, 2013

TABLE 1: FEDERAL GOVERNMENT EXPENDITURE ON HEALTH: 1980

Year Total Federal

Expenditure N

Million

1980 14968.5 155.3

1981 11413.7 119.8

1982 11923.2 155.8

1983 9636.5 143.6

1984 9927.6 139.1

1985 13041.1 167.7

1986 16223.7 279.2

1987 220.18.7 166.9

1988 27749. 260.0

1989 41028.3 326.6

1990 60268.2 401.1

1991 66584.4 619.4

1992 92797.4 837.4

1993 191228.9 2331.6

1994 160893.2 2066.8

1995 248768.1 3335.7

1996 337217.6 3192.0

1997 428215.2 4860.5

1998 487113.4 4860.5

Source: Central Bank of Nigeria, Statistical Bulletin (1980

TABLE 2: FEDERAL GOVERNMENT EXPENDITURE ON HEALTH: 1999

Year Total Federal

Expenditure N

Million

1999 947690.0 8793.2

2000 701059.4 11612.2

2001 11923.2 155.8

2002 9635.7 154.2

2003 9927.6 153.1

2004 14121.1 185.7

2005 16223.7 279.2

2006 27718.7 168.9

2007 27719.2 260.0

2009 42222.3 326.6

2010 60444.7 366.8

Source: Central Bank of Nigeria, Statistical Bulletin (1999

From table 1 and 2 above, it is evidently clear that the Federal government expenditure on health in Nigeria between

1980 and 1998 and 1999 and 2010 is not only inadequate, it smacks of poor realization of the benefits and value of

the multi-sectoral nature and the cyclical link of

For instance, the health expenditure as a ratio of total federal expenditure in Nigeria between 1980 and 2010 did not

exceed 2.9 percent. In fact, the ratio was as low as 1.1 between 1

infinitesimal and inconsequential, particularly against the background of the World Health Organization’s

recommendation that a minimum of 5% of the total budget allocation should be for the Health sector.



43

TABLE 1: FEDERAL GOVERNMENT EXPENDITURE ON HEALTH: 1980-1998

Federal Expenditure on

Health NMillion

Expenditure as

a Ratio of Total

Federal

Expenditure

GDP at

Current Factor

Cost

155.3 147.5 302.5 2.0 49632.3

119.8 128.4 248.2 2.2 50456.6

155.8 130.2 286 2.4 515170.3

143.6 136.0 279.6 2.9 56709.8

139.1 51.1 190.2 1.9 63006.2

167.7 56.6 223.9 1.7 71368.1

279.2 81.2 360.4 2.2 721128.2

166.9 69.5 236.4 1.1 106883.2

260.0 183.2 443.2 1.6 142678.3

326.6 126.0 452.6 1.1 222457.6

401.1 257.0 658.1 1.1 257873.0

619.4 137.6 757 1.1 320247.3

837.4 188.0 1025.4 1.1 544330.7

2331.6 352.9 2684.5 1.4 691600.0

2066.8 961.0 3027.8 1.9 911070.0

3335.7 1725.2 5060.9 2.0 1960690.0

3192.0 1659.5 4851.5 1.4 2740460.0

4860.5 7123.8 11984.3 2.5 28350

4860.5 7123.8 11984.3 2.5 276570.0

Source: Central Bank of Nigeria, Statistical Bulletin (1980-1998).

TABLE 2: FEDERAL GOVERNMENT EXPENDITURE ON HEALTH: 1999-2010

Federal Expenditure on

Health NMillion

Expenditure as

a Ratio of Total

Federal

Expenditure

GDP at

Current Factor

Cost

8793.2 7386.8 1910 1.7 3225990.0

11612.2 6569.2 18181.8 2.6 50456.6

155.8 130.2 286 2.4 510170.3

154.2 135.3 278.5 2.8 56720.1

153.1 136.2 191.3 1.8 630172.9

185.7 135.6 229.4 1.9 75539.1

279.2 134.7 3753 2.1 74343.2

168.9 70.5 236.4 1.8 106883.2

260.0 183.2 239.2 1.9 14488.3

326.6 184.0 452.6 1.8 222457.6

366.8 189.0 461.5 1.9

Source: Central Bank of Nigeria, Statistical Bulletin (1999-2010).

t is evidently clear that the Federal government expenditure on health in Nigeria between


sectoral nature and the cyclical link of the sundry relevant sectors as far the health care system is concerned.


exceed 2.9 percent. In fact, the ratio was as low as 1.1 between 1987 and 1992 that it can at best be described as



www.iiste.org

GDP at

Current Factor

Cost

Expenditure as

a ratio of GDP

49632.3 0.61

50456.6 0.49

515170.3 0.50

56709.8 0.50

63006.2 0.30

71368.1 0.31

721128.2 0.50

106883.2 0.22

142678.3 0.31

222457.6 0.20

257873.0 0.26

320247.3 0.24

544330.7 0.19

691600.0 0.39

911070.0 0.33

1960690.0 0.26

2740460.0 0.18

2835000.0 0.20

276570.0 0.20

GDP at

Current Factor

Cost

Expenditure as

a ratio of GDP

3225990.0 0.50

50456.6 0.49

510170.3 0.51

56720.1 0.52

630172.9 0.53

75539.1 0.54

74343.2 0.51

106883.2 0.52

14488.3 0.50

222457.6 0.20

3.0 0.26

t is evidently clear that the Federal government expenditure on health in Nigeria between


the sundry relevant sectors as far the health care system is concerned.


987 and 1992 that it can at best be described as





Vol.3, No.4, 2013

Finally, communities and competitors are to be managed by public health organizations and institutions by

undertaking health education and enlightenment programmes that will expose the people to globally recognized and

acceptable health culture, ethics, sta

preventive health care in Nigeria. Public sector health institutions have to also manage the competition from the

environment where the private health institutions are operating, b

procedures, products and services so that they can enjoy the cutting edge advantage. In this wise, government should

induce competition among public health providers by developing the quasi

competition on quality is evident when public sector payers pay health service providers on behalf of consumers who

are free to choose between providers or suppliers as Halonen and Propper (2009) rightly articulated. Thus,

competition between public and private sector health service providers is beneficial mainly because it enhances

health service delivery in a market- driven environment. Arguably, with competition from the for

public health organizations and instituti

seekers. And since health care in the private sector consisting of traditional medicine and modern health care services

are provided largely by public sector employees that set up pr

require motivation for commitment and loyalty to the public service and this will bring about significant

improvements in the availability of and accessibility to health facilities and services, pa

dwellers. Health institutions and organizations can equally develop more intensive training programs to train the

people who have been unable to obtain jobs because of lack of skills and resultantly compensate their operating

environment in a socially responsible way.

8. Conclusive Remarks and Recommendations

The Nigerian public sector where performance is seemingly an exception rather than the rule and public offices have

for too long been showcases for the tripod evils of inefficie

impediments to effective implementation of government policies (Servicom 2008), the real victim is the nation which

is denied effective positive contribution of the public sector to national development

Nigerian people who are being short

of the sector. At least, these organizations embody the values of the Nigerian society and the nature and ch

the public sector environment in Nigeria is such that the ability of the sector to meet social needs in the face of

critical national objectives is constrained, especially with the central weakness of public institutions that is typified

by dependence upon a budget that perpetuates economic survival rather than on payment from a satisfied customer.

The age-long emergent dilemma has become a problematic in Nigeria where there is no service culture and where the

much sermonized development planning

In the Nigerian public health sector, it is truism to assert that the standard and nature of service is a reflection of the

poor management of the operations, processes, activities and efforts of t

government, suppliers, creditors and the challenge of the competitors that are critical to and affect the service

delivery in the sector. It is the disconnect in the management orientation and practice as far as the he

system and service delivery is concerned that has made genuine and real integration, synergy and eclectic approach

almost an exception rather than the rule in Nigeria. This is the plausible explanation for the relatively lack of

interface between and among the stakeholders and their concerns as well as service failure in the health sector that is

at the heart of and resultantly central to sustainable development in Nigeria because of its link with every other sector.

It is therefore instructive to add that the development of any society including Nigeria is inextricably tied to its health

standards and the health status of its citizens. Engendering and actualizing quality, result

health service delivery in

Nigeria ultimately demands a clear-

and multi-sectoral reforms which, will serve as a catalyst for a full

attitudinal predisposition and genuine commitment to pragmatical

is a product of the totality of the resource generated, allocated, deployed, coordinated and utilized in a synergistic

and complementary fashion There is therefore arguably the need for a restructured r

revitalized, repositioned and renewed service based Nigerian public sector environment that would be genial to and

clement for a quality-driven and performance

synergistic mentality and systemic practice.



44

inally, communities and competitors are to be managed by public health organizations and institutions by


acceptable health culture, ethics, standards and habits and consequently reduce the burden of disease and promote


environment where the private health institutions are operating, by continually improving on their processes,


induce competition among public health providers by developing the quasi-market (Le-Grand 2010)



en public and private sector health service providers is beneficial mainly because it enhances

driven environment. Arguably, with competition from the for

public health organizations and institutions will strive to deliver exceptional and tailor


are provided largely by public sector employees that set up private practice after office hours, public health personnel


improvements in the availability of and accessibility to health facilities and services, pa



ment in a socially responsible way.

Conclusive Remarks and Recommendations


for too long been showcases for the tripod evils of inefficiency, corruption and poor management that have become


is denied effective positive contribution of the public sector to national development and at the receiving end are the

Nigerian people who are being short-changed by the consequential effects of the poor and appalling quality service

of the sector. At least, these organizations embody the values of the Nigerian society and the nature and ch



ndence upon a budget that perpetuates economic survival rather than on payment from a satisfied customer.

long emergent dilemma has become a problematic in Nigeria where there is no service culture and where the

much sermonized development planning efforts and programmes are lacking clear-cut orientation.


poor management of the operations, processes, activities and efforts of the significant groups like employees,


delivery in the sector. It is the disconnect in the management orientation and practice as far as the he



en and among the stakeholders and their concerns as well as service failure in the health sector that is


to add that the development of any society including Nigeria is inextricably tied to its health

standards and the health status of its citizens. Engendering and actualizing quality, result

-cut service culture and development orientation that will encapsulate integrated

sectoral reforms which, will serve as a catalyst for a full-blown re-orientation,

attitudinal predisposition and genuine commitment to pragmatically efficacious service delivery for service provision


and complementary fashion There is therefore arguably the need for a restructured r


driven and performance-oriented health sector through proactive and pragmatic management

rgistic mentality and systemic practice.

www.iiste.org

inally, communities and competitors are to be managed by public health organizations and institutions by


ndards and habits and consequently reduce the burden of disease and promote


y continually improving on their processes,


Grand 2010). The impact of



en public and private sector health service providers is beneficial mainly because it enhances

driven environment. Arguably, with competition from the for-profit private sector,

ons will strive to deliver exceptional and tailor-made services to health


ivate practice after office hours, public health personnel


improvements in the availability of and accessibility to health facilities and services, particularly among rural




ncy, corruption and poor management that have become


and at the receiving end are the

changed by the consequential effects of the poor and appalling quality service

of the sector. At least, these organizations embody the values of the Nigerian society and the nature and character of



ndence upon a budget that perpetuates economic survival rather than on payment from a satisfied customer.

long emergent dilemma has become a problematic in Nigeria where there is no service culture and where the

cut orientation.


he significant groups like employees,


delivery in the sector. It is the disconnect in the management orientation and practice as far as the health sector



en and among the stakeholders and their concerns as well as service failure in the health sector that is


to add that the development of any society including Nigeria is inextricably tied to its health

standards and the health status of its citizens. Engendering and actualizing quality, result-oriented and performing

cut service culture and development orientation that will encapsulate integrated

ly efficacious service delivery for service provision


and complementary fashion There is therefore arguably the need for a restructured re created, re-engineered,


oriented health sector through proactive and pragmatic management



Vol.3, No.4, 2013

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